Leuprorelin for breast cancer

Hormones are chemicals that our bodies make. Hormones act as messengers and help control how cells and organs work. Hormonal therapies are drugs that change the way hormones are made or how they work in the body.

Oestrogen can encourage breast cancer to grow. Leuprorelin stops the ovaries making oestrogen and lowers the level of oestrogen in the body. You can only have leuprorelin if you have not been through menopause. You may have it along with other hormonal therapy drugs, or on its own.

Leuprorelin is given as an injection under the skin (subcutaneously) or into a muscle (intramuscular).

There are different types of leuprorelin. Some are given once a month and some are given once every 3 months. Your nurse or doctor will talk to you about your treatment plan.

The practice nurse at your doctor’s surgery usually gives you the injections. If you are not able to visit the surgery, a district nurse can give you the injections at home. 

The area where the injection is given (the injection site), may become:

• bruised 
• painful
• swollen 
• red or darker. 

If this happens, let your doctor know. Painkillers may help. 

If you are taking any medicines to thin your blood, tell your doctor or nurse. This may make you bruise more.

Hot flushes are a common side effect of this treatment. During a flush, your neck and face may feel warm. If you have white skin, your skin may look red. If you have black or brown skin, your skin colour may deepen. Flushes may last up to 5 minutes. You might also have sweats or feel anxious or irritable during a hot flush.

Here are some things you can do to reduce the effects of hot flushes:

• Wear natural fabrics, such as cotton.
• Wear layers so you can remove clothes as needed.
• Use cotton sheets and layers of bedding you can remove.
• Try cooling pads or pillows to keep you cool.
• Keep rooms cool or use a fan.
• Have cold drinks and avoid caffeine and alcohol. 

You might have fewer hot flushes as your body adjusts to this treatment. You could try therapies to help you cope with hot flushes, such as:

• talking therapies like cognitive behaviour therapy (CBT)
• controlled breathing exercises
• yoga 
• acupuncture. 

If they do not improve, talk to your doctor. Certain drugs can help to improve hot flushes. 

Flushes usually stop a few months after treatment ends. But some people continue to have them.

This treatment can affect your sex drive (libido). If you are worried about the effects of treatment on your sex life, you can talk to your doctor, nurse or pharmacist. They can give you help and support. 

If you have periods, they should stop while you are having this treatment. This is caused by the lower levels of oestrogen in the body. If this does not happen, tell your doctor.

When you finish treatment, your periods are likely to start again. But you might go through a natural menopause during treatment. This will mean that your periods do not come back.

You can still become pregnant even if your periods stop. This means you will need to use effective contraception. You can discuss this with your doctor or nurse.

This treatment can cause vaginal dryness. Non-hormonal creams, gels or lubricants can help with vaginal dryness and any discomfort during sex. You can buy these from a chemist, or your doctor can prescribe them.

You might have slight vaginal bleeding for a short while:

• when you start treatment
• if you change from 1 hormonal treatment to another.

Vaginal dryness can also cause bleeding. Tell your doctor or nurse if you have any vaginal bleeding, especially if it lasts for more than a few days.

Feeling tired is a common side effect. Try to pace yourself and plan your day so you have time to rest between activities.

Being physically active can help to manage tiredness and give you more energy. It also:

• helps you sleep better
• reduces stress
• improves your bone health.

If you feel sleepy, do not drive or operate machinery.

This treatment may cause headaches. If you have headaches, tell your doctor, nurse or pharmacist. They can give you advice about painkillers that may help. Tell them if the headache does not get better, or gets worse.

Leuprorelin can make you feel sick (nausea) but this is usually mild. If it does not improve, your doctor can give you anti-sickness drugs to help.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual. 

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

You may get pain in your muscles or joints. If this happens, tell your doctor or nurse. They can give you advice and painkillers or other drugs to help. Being physically active and keeping to a healthy weight may help with the pain. It can keep your joints flexible and reduce stress on them. If the pain does not get better, tell your doctor or nurse. They may talk to you about changing to a different hormonal drug.

You may feel low or depressed, or have mood swings, during this treatment. Talking to family and friends about how you feel might help. If mood changes last for more than a few weeks, tell your doctor, nurse or pharmacist. They can talk to you about different ways to manage low mood or depression.

You may notice changes in your memory. You may also find it harder to concentrate. 

To help you remember things, try using: 

• reminder alarms or notes on your phone 
• a diary, calendar or phone app 
• a notebook you carry with you.

Taking this treatment for several months or more can increase the risk of bone thinning. This is called osteoporosis. It can make you more likely to get a broken bone (fracture). 

You may have bone density scans to check your bone health before and during treatment. These scans can diagnose osteoporosis or osteopenia (low bone density) so that it can be monitored. If your scan shows osteoporosis, your doctor usually prescribes:

• drugs to protect your bones called bisphosphonates
• calcium and vitamin D supplements. 

Regular exercise where you support your body weight, like walking, running and dancing, can help look after your bones. This is called weight-bearing exercise. Other types of strength exercises are also helpful. If you have any bone thinning or the cancer is affecting your bones, get advice from your cancer team first. 

Eating a healthy diet and not smoking also helps take care of your bones.

You may gain weight when you are having this treatment. Eating healthily and being active can help you keep to a healthy weight. Your doctor, nurse or dietitian can give you more advice.

This treatment may affect how your liver works. This is usually mild. You will have blood tests to check how well your liver is working.

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• throbbing pain or swelling in a leg or arm
• reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
• suddenly feeling breathless or coughing.

Always call 999 if you have:

• chest pain
• difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Your doctor, nurse or pharmacist will advise you not to get pregnant while having this treatment. The drug may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use, for example using barrier contraception instead of hormonal contraception like the oral pill
• how long after treatment you should continue to use contraception.

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.